Congressional Record, Volume 152 Issue 56 (Wednesday, May 10, 2006)

[Congressional Record Volume 152, Number 56 (Wednesday, May 10, 2006)]
[Senate]
[Pages S4249-S4257]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

HEALTH CARE WEEK

Mr. KENNEDY. Madam President, for those Americans who believe the
Senate was going to have a debate this week on health care policy--and
they have been watching the activities in the Senate this morning--they
must be mystified about how and whether we are going to have a debate
at all. We will know the answer to that at 2

[[Page S4250]]

o'clock, when the majority leader will address the Senate.
The best judgment now is, for all intents and purposes, that the
debate on the issue of health care will be terminated through a
parliamentary process that will be worked out, making it impossible to
offer amendments to the underlying bill, which is the usual way of
proceeding in the Senate. Instead of debate on health care, we will
find that time will move on, there will be debate and discussion about
some of the tax issues tomorrow and probably voting on cloture on the
underlying Enzi legislation.
Let me point out how disappointed I am in this result. We are aware
the leader said we were going to have a Health Care Week in early May,
and we would have a chance to debate issues which relate to health
care. Health care is a matter of enormous importance to families all
over this country--we all know that. As Members of this Senate, we
cannot go to our home States without being exposed to different aspects
of the health care crisis. Certainly this is true more so today,
perhaps, than in recent times. We are very disappointed that the Senate
will not have the opportunity to address some of the underlying issues
on health care.
We now have 46 million Americans who do not have health insurance.
The total number of uninsured has been increasing by about a million a
year over the period of the last 6 years. There is every indication
that this increase in the number of uninsured is a phenomenon that is
going to continue.
We know that in terms of the coverage, an increasing number of
Americans are only a paycheck away from losing their health care
insurance. They are very concerned about losing coverage, especially
with all of the changes we see in terms of the economy and the
challenges we are facing in terms of good jobs, good benefits, and
health care protection.
For all of these reasons, Americans are concerned about losing health
care insurance.
We have increased the total health care spending over 6 years from
$1.3 trillion to $1.9 trillion. We are spending $600 billion more on
health care and yet 6 million people have lost coverage. The numbers
related to health are spending and the uninsured are going in the wrong
direction. We have a growing number of uninsured, yet we are paying
more in taxes and for the costs of health care. This does not make a
great deal of sense. We ought to get about the business of trying to
deal with the problem of decreasing numbers of insured Americans and
increasing health care spending.
My State of Massachusetts has tried to get its arms around the
problem of inadequate coverage of health are insurance, and I commend
our leaders in Massachusetts for attempting to do that. We need to do
that here in the Senate. Premiums have gone up 73 percent in the last 6
years. Wages have gone up approximately 13 percent. How do average
working families possibly get ahead and afford the kind of health care
they need when we see the costs of health care going right through the
roof?
It is not just the costs of health care creating problems for working
families. We know that working families are paying more in terms of
gasoline, and they are paying more in terms of higher education. This
last winter, in many instances my constituents were paying a great deal
more on fuel assistance because of the rising costs of fuel. While
costs are rising, wages are not.
All of these challenges are out there for Americans. Beyond this, we
are in the age of the life sciences with new possibilities for
breakthrough drugs in Alzheimer's and Parkinson's disease. If we had a
break in terms of Alzheimer's disease and we were able act on that
breakthrough, we would empty one-third of the nursing home beds in my
home State of Massachusetts. There are profound implications in terms
of the quality of life Americans people could live. Our influence could
not only improve the quality of life for people in the United States
but it could also influence the quality of life of people around the
world. Though unimaginable, we have made reductions and cuts in NIH
research at a time when we have splendid opportunities for
breakthroughs in health care.

We thought we might have an opportunity to have a health care debate
on stem cell research, an issue which led to legislation being passed
in the House of Representatives. The legislation, which we believe a
clear majority of this Senate favors, is now waiting on the calendar. I
call it the legislation of hope--there are no guarantees about what
stem cell research might be able to do in the future, but it will
provide great hope for millions of families that have Parkinson's,
Alzheimer's, spinal cord injuries, and so many other illnesses.
We should be able to do something that Senator Nelson from Florida
has been talking about for weeks. Unless we take action, approximately
8 million American seniors will be paying more for prescription drugs
if they do not file under the Medicare prescription Part D drug program
in the next few days. We know most seniors are living on fixed incomes,
and they will be paying hundreds of millions of dollars more if they do
not file under Medicare Part D drug program. We have an opportunity to
do something about this problem, but we are being blocked.
We are blocked on stem cell research. We are blocked on doing
something for our senior citizens in terms of penalties related to the
Medicare Part D drug program. We are blocked from perhaps changing our
law and permitting our Medicare system to bargain with the
pharmaceutical companies to get lower priced prescription drugs for our
seniors as we do in the VA system. All of our seniors understand that
Medicare should be able to negotiate lower prices for prescription
drugs, but we are prohibited from doing that by law. There is virtual
unanimity among the Democrats to change Medicare's ability to bargain
for lower drug prices. Do we have an opportunity to do that? No, we
cannot do that, either. We are prohibited from having that debate,
having that discussion, having that vote which would mean so much to
the quality of life of so many of our seniors, let alone the issues
regarding the possibilities of reimportation of drugs, which has been
an issue that many Members know can make a big difference in terms of
availability of prescription drugs. However, we are not going to have
that opportunity.
Finally, we are not even going to have the opportunity to see the
small business proposal which has been prepared by Senator Durbin and
Senator Lincoln which I strongly support. Their proposal can make a
difference for small businesses. It helps small businesses retain
health insurance for their workers and will provide incentives for
those small businesses, the engine of the American economy, to bring
people back into health care coverage. We ought to have the debate
about Senator Durbin and Senator Lincoln's small business health plan
proposal. Let the Senate make a judgment, a decision, about whether
they favor, on the one hand, the proposal by Senators Lincoln and
Durbin or, on the other hand, Senator Enzi. Let's have the votes and
call it as we see it. But we are virtually prohibited from having that
vote in the Senate.
Most Americans believed, when they elected their representatives,
that they were going to come here, they were going to learn these
issues, and they were going to tell their representatives what was on
their minds. The Senators were going to learn the issues and then have
a voice and a vote and try to move that process forward. Certainly that
is what we all believe is our responsibility as elected officials. We
thought we were going to have these debates and votes on health care
this week, but we are not. I believe that this is a grave
disappointment. It is an abdication of our leadership in the Senate on
an issue which is of overwhelming importance--the quality of health
care and the affordability of health care for the millions of American
people.
I yield the floor.
The PRESIDING OFFICER. The Senator from New Mexico.
Mr. BINGAMAN. Madam President, first I commend my colleague, Senator
Kennedy, for his leadership on this very important issue and all the
many other issues on which he provides great leadership in the Senate.
I rise today to oppose this Senate bill, 1955. I believe it is well
intentioned. I have the greatest respect for Senator Enzi and the role
he is playing

[[Page S4251]]

as chairman of the Committee on Health and Education, on which I am
privileged to serve.
However, I also believe this particular proposal, S. 1955, is flawed
and has many potential unintended consequences which could have a
devastating impact on millions of Americans who currently have health
insurance coverage. It is for that reason that I am a strong supporter
of the alternative to which Senator Kennedy referred; that is, the
alternative Senators Durbin and Lincoln have put together which I will
speak about in more detail in a minute.
I also suggest an alternative proposal that would bridge the gap
between these two approaches and would build on the bipartisanship we
clearly need in order to make any progress on health care issues in the
remaining weeks of this Congress, which are diminishing rapidly, as all
are well aware.
First and foremost, we need to keep in mind the important tenet that
is referred to often when we talk about health care; that is, first, do
no harm. That is what physicians are taught when they go to medical
school. Clearly, that is something we should be taught when we come to
the Senate.
One of the most significant concerns I have with this legislation
that is pending in the Senate is that the language contains sweeping
preemptions of literally hundreds of State insurance laws, not just for
association plans or for the self-employed or even just for small
businesses, but the legislation as presented to us preempts those State
laws for large businesses as well.
Consequently, for the millions of people who currently have insurance
coverage and count on consumer protections and benefits--including
coverage of cancer screenings, diabetes treatment and supplies,
immunizations, well-baby care, prenatal care or whatever benefits and
protections their States require be included in insurance policies--
that security is wiped out by S. 1955.
In short, the bill literally puts at risk the health security of
millions of Americans by preempting longstanding State insurance laws
to impose an untried, untested proposal throughout the country.
While I certainly do not disagree with the idea that there may be
insurance laws and mandates that States have enacted that are not
needed, I do think most often the mandates and the provisions that are
adopted at the State level are adopted in response to real needs those
State legislatures have perceived and real crises that have been
pointed out in those States. As such, by preempting those consumer
protections, there are real national goals that we all share that would
be undermined.
For example, we have a national goal to improve immunization rates
among children. So why should we backtrack and potentially undermine
what the States have done to ensure that insurance plans offered in the
individual States provide for coverage of a full set of immunizations
for their children?
While a number of Senators have come to the Senate floor condemning
various State mandates, who really thinks we should not be covering
cancer screenings, as an example, and treatment and prevention or
diabetes education and supplies?
Some will argue that the benevolent insurance industry would never
fail to cover these items. But, in fact, there are insurance products
for sale in this country in some States--for example, in Ohio--that do
not cover diabetes supplies and education, precisely because there is
no requirement they do it.
State insurance laws, including mandates or laws regarding market
conduct of insurance plans, were passed because of real problems that
were perceived in the insurance market. Consequently, it makes little
sense to preempt literally hundreds of State laws overnight and to put
all hope that insurers would have to offer businesses a plan offered to
State employees in one of the five most populated States. That is what
is touted as the guarantee of consumer protections.
As the bill now reads, if a plan fails to offer certain protections,
and it is being offered to employees in one of these five most
populated States by that State, then that is a minimum that is
acceptable throughout the country with regard to all insurance plans. I
do not see why the people of New Mexico or the people of any other
State should be at the mercy of what one of the Governors of these
large States decides to offer to that State's employees.
The five Governors are certainly respected public servants--Governor
Schwarzenegger, Governor Bush, Governor Perry, Governor Pataki, and
Governor Blagojevich--that is a mouthful, Madam President--but I do not
see why any of those Governors should be able to lessen the protections
that we provide to consumers in New Mexico.
If Governor Bush passes a barebones package in Florida, do all of the
people of my State of New Mexico have to fear losing health benefits?
That would be the effect of the pending legislation.
In fact, for rural States, a package in the five most populated
States is very likely to fail to recognize the special challenges we
have in rural communities. Let me give you one example.
In New Mexico, we have a mandate for access to psychologists. If you
sell a health insurance policy in New Mexico, you have to cover access
to psychologists. This was passed in response to the fact that our
State leads the Nation in the number of suicides per capita. Also,
there are very few psychiatrists who are located in areas outside of
Albuquerque and Santa Fe, which is our more urban part of the State.
So our State leaders, in part due to the leadership of my colleague,
Senator Domenici, have been making great strides with respect to mental
health coverage and benefits in New Mexico. But that could be
undermined by this pending legislation. Literally overnight, our State
mandates could be preempted and replaced with the allowance that
insurance companies could provide whatever benefits they desire or that
any plan offered by the five most populous States in the country to
their employees would be adequate in New Mexico.
I would note that even though 42 States have requirements that
insurance plans offer access to psychologists, Florida does not, and
may not, in their State employees' plan. Therefore, any insurer could
adopt that plan and hundreds of thousands of people would lose access
to mental health professionals in a State such as mine, New Mexico.
This is one example of real regional or local issues that I believe are
not adequately addressed in this bill.

Another simple but important example of a problem with the
legislation is that most States require insurance plans to cover
newborns and adopted children and adult disabled children. This bill
would undermine such requirements. Why should the Senate undermine this
critical coverage of some of our Nation's most vulnerable children?
Fundamentally, we should not be encouraging underinsurance and
benefit insecurity among most Americans as part of a bill that is
intended to increase health coverage among small businesses, but,
unfortunately, that is the unintended consequence of S. 1955.
It is why literally hundreds of national and State-based
organizations have come out in opposition to S. 1955, including the
Nation's State health insurance commissioners and 41 of our States'
attorneys general. All of these groups and individuals are opposing S.
1955 precisely because the legislation contains numerous provisions
that, as the attorneys general write, ``erode state oversight of health
insurance plans and eliminate important consumer protections.''
While some organizations have literally tried to claim that the
attorneys general did not know what they were doing by taking the
position they have taken, I was an attorney general of my State, and I
can assure you those attorneys general knew exactly what they were
doing when 41 of them joined together in a letter of opposition to S.
1955. They surely know a lot more about the laws of their States and
the consequences of eroding insurance laws than some of the groups that
are attempting to criticize them in this debate.
But even if you do not believe the attorneys general, the bill's text
reads clearly it will ``supercede any and all state laws'' applicable
to small business health plans as well as State laws regulating all
other types of health insurance plans, not small business health plans,
in six key areas: No. 1,

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mandated benefits; No. 2, rating requirements; No. 3, internal appeals;
No. 4, rate and form filing; No. 5, market conduct reviews; and, No. 6,
prompt payment of claims. So in all of those six areas, this
legislation would override whatever the States have previously done.
So what are the consequences? As the attorneys general write:

The point is that history has shown that eliminating state
regulation of insurers has had extremely negative
consequences for consumers, and there is no reason to exempt
any insurer from the important consumer protections afforded
by state regulation.

The sweeping nature of preemption of State laws and oversight is
fairly breathtaking in this legislation. It is surprising to see how
many of our colleagues, who are typically advocates for States rights,
have embraced this legislation. It culminates with a provision in which
insurance companies are afforded the right to sue States in Federal
court.
The legislation, first of all, overturns and preempts this
longstanding State authority over State insurance matters. Secondly, it
imposes a new Federal system upon the States. Third, it declares States
as nonadopted States if they do not conform their laws to the newly
imposed Federal system. And, finally, it allows insurers to sue States
in Federal court if they do not like the way the States are
administering the federally imposed law.
Somewhere, it seems to me, the goal of the legislation has been lost.
The stated goal was to give small businesses greater health insurance
purchasing power and to reduce administrative costs in the purchase of
health insurance. However, there are, in my opinion, far better
approaches to achieving that goal than to gut State oversight of health
insurance plans and to eliminate these important consumer protections.
For instance, eliminating the guarantee of coverage of insulin makes
any insurance product meaningless to someone who has diabetes. As a
result, I am a supporter--I know Senator Kennedy indicated his strong
support--and I also strongly support the legislation introduced by
Senators Durbin and Lincoln precisely because it would address the
affordability problems for businesses in the small group insurance
market by giving them the ability to access a large purchasing pool
which would be modeled on the successful Federal Employees Health
Benefits Program, FEHBP. It would do so without eroding any of the
consumer protections afforded people in State insurance laws and
oversight.
Under this Durbin-Lincoln bill, small businesses would be allowed to
band together in a large purchasing pool that would reduce premiums,
reduce administrative costs, and give every small business and their
employees a wide choice of plans. The amendment harnesses the power of
market competition to bring down health care costs by using a proven
negotiator that provides Federal employees across the Nation with
access to affordable health care.
Let me make it very clear that we are not in any way affecting the
health care coverage of Federal workers with this proposal, this
Durbin-Lincoln proposal. Small businesses and their employees who
choose to participate and buy their health care through this purchasing
pool would be buying their health care through a separate pool--
separate from Federal workers--but still a very large pool of small
businesses around the country with 100 or fewer employees.
Last year, there were 249 private health insurance plans that
participated and competed for the business of the FEHBP enrollees. This
system would also benefit small employers. It would do so without
undermining the benefits and coverage of large employers or the
consumer protections that are afforded everyone under our State
insurance laws.
What people fundamentally want from their insurance policy is
something that is truly there when it is needed. Unfortunately, S. 1955
preempts that security and creates more unintended harm than good
through an untested and unproven model of State preemption. In sharp
contrast, this alternative that Senators Durbin and Lincoln--and I am
proud to be a cosponsor--are proposing achieves the goals of helping
small business in the underlying bill through a proven mechanism that
each and every one of us and our staffs benefit from without upsetting
the security that the health insurance marketplace provides to millions
of Americans around the country.
There is also another alternative that I think is most promising for
some type of health care reform in the reasonably near future in this
Congress. This is bipartisan legislation that I was proud to join
Senator Voinovich in introducing yesterday. This legislation, entitled
the Health Partnership Act, is intended to move beyond the political
gridlock we have in Washington on health care reform. I think that
gridlock is, unfortunately, highlighted by the very debate we are
having in the Senate this week.
Instead, the proposal Senator Voinovich and I have introduced sets us
on a path toward finding solutions to affordable quality health care
for all Americans by creating partnerships between the Federal
Government and State and local governments and private payers and
health care providers to implement some different and promising
approaches to health care. In contrast to preempting State laws and
solutions, the Health Partnership Act, which Senator Voinovich and I
introduced yesterday, would provide for Federal funding and support to
State reform efforts such as that recently enacted in the State of
Massachusetts to reduce the number of uninsured, to reduce cost, and to
improve the quality of health care. A Federalist approach to health
reform, in sharp contrast to state preemption, would encourage a broad
array of reform options that would be closely evaluated to see what is
working and what is not.
Justice Brandeis is famous for his statement in 1932:

It is one of the happy incidents of the federal system that
a single courageous State may, if its citizens choose, serve
as a laboratory; and try novel social and economic
experiments without risk to the rest of the country.

The Health Partnership Act encourages this type of State-based
innovation through a partnership rather than through preemption. This
would help the entire Nation to better address both the policy and the
politics of health care reform. As the debate before us underscores,
there is not a consensus at the Federal level on any one approach.
Instead of preempting State laws and innovation, we should be
encouraging States to adopt a variety of approaches that may help us
all better understand what does work and what does not. Rather than
fighting to a standstill over whether the Enzi bill or the Durbin bill
is the best approach, I would argue that the best solution would be to
have a few States experiment with a model based on Senator Enzi's bill,
if they chose to do so; other States experiment with a model based on
the Durbin-Lincoln approach, if they chose to do so; and other States
adopt alternative reforms such as those that have recently been passed
by Massachusetts, Maine, New Mexico, New York, Illinois, Oregon, and
Montana. This would also include encouraging reforms in local areas
such as the three-share initiatives in a number of communities.
If given the opportunity--and there is still uncertainty about
whether I will have that opportunity--I plan to offer an amendment that
would give the States the choice between being covered by the Enzi
model or being covered by the Durbin-Lincoln model for their small
businesses. Therefore, the amendment would add the Durbin-Lincoln
language to the Enzi bill with additional language that gives States
the choice of deciding which approach to take.
If the proponents of S. 1955 are so confident that their approach is
the best, let's let the States choose for themselves.
The PRESIDING OFFICER. By unanimous consent, it was agreed that each
Senator would be limited to 10 minutes under morning business. The
Senator has exceeded that time.
Mr. BINGAMAN. I ask unanimous consent that I be given an additional
minute.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. BINGAMAN. From monitoring the various reform approaches that are
taking place around the country, it is far more likely that we might
learn from those efforts to actually find a mutual solution to the
problem than to

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continue to have needless health care debates on the Senate floor. Just
as States passed expansions of coverage for children prior to Federal
enactment of the State Children's Health Insurance Act, we should once
again let the States lead the way to reform. When the passions of this
week die down and there appears to be nothing left standing, I hope
people will take a serious look at the bipartisan legislation Senator
Voinovich and I, Senators Akaka and DeWine have introduced. It is
supported by groups such as the American Hospital Association, the
American Medical Association, the National Association of Community
Health Centers, and numerous other national and community-based
organizations.
As speaker after speaker has noted, it is well past the appropriate
time to act. I hope we can act and actually legislate in this area
during this Congress.
I yield the floor.
The PRESIDING OFFICER. The Senator from North Carolina.
Mr. BURR. Madam President, many Members over the last several days
have come to talk about health care, specifically the effects on small
business. I know my colleague didn't mean it the way it sounded, that
this was a ``needless'' debate about health policy. It is a very needed
debate about health policy.
In North Carolina, 98 percent of the firms with employees are
considered small business. Small business is who we are here to
represent in this piece of legislation. Small business is the American
business today that can't afford to offer health care as a benefit to
its employees. Why? Because small business has few employees. They
don't have the ability to negotiate in the volume that large
corporations do.
Some have argued this is not a crisis. In North Carolina, we have 1.3
million uninsured North Carolinians; 900,000 of that 1.3 million are
individuals in a family or on their own where an individual works full
time. There is somebody in the family who works full time in that
house, be it the individual or a family member, who would have the
option to be insured under this bill, at least individually or, if not,
under a family plan, and our uninsured population from North Carolina
could go from 1.3 million to 400,000 with the passage of one piece of
legislation.
This is not a needless debate. This is a needed debate. This is a
population that today has two choices--nothing and nothing. Because an
employer has found that health insurance is cost prohibitive. What is
the employer's choice? I can provide you health care, but I can't stay
in business. What good have we done for the employees, whether they are
in North Carolina or anywhere else, if the option is, I can give you a
benefit, but I can't keep you employed? This is to attempt to try to
bring the same ability that big business has to small business, to
negotiate as an association, as a group. This is the most natural thing
I could think of that we could do to begin to relieve the pressure.

Does it solve health care? Absolutely not. It will take much more
pressure from the American people for us to tackle the real structural
changes needed in health care. But let me relate some stories from
North Carolina and around the country. This comes from Hickory, NC.
This woman owns a custom plumbing and heating business. She says she
would like to be able to offer her employees and their families
affordable health care coverage.

As a parent and employer, I know the importance of having
affordable insurance and the financial devastation that
occurs when you have no coverage. Unfortunately, there has to
be a tradeoff.

She says she only has one of two options to keep her doors open--
either employees have no insurance or they don't have a livable wage.
Another one from an area in North Carolina, a small business owner
has provided health insurance for his employees at no cost to them for
the past 10 years. However, every 2 or 3 years he spends at least 2
months shopping for insurance because he knows that the rate increase
is coming. We have all faced that. He would like to continue to provide
insurance for his employees but he doesn't think he can hold out much
longer.
Think about the employees. Think about the families.
This one is from Greenville, SC, a small business owner who says that
providing health insurance is becoming unbearable for small businesses
such as hers. She calls it a ``hardship.'' She is a widow. She is self-
employed. Her health insurance is an expense she can hardly afford.
Similar to many of her employees, she has a $5,000 deductible, and her
monthly premium consistently increases 35 to 40 percent every 6 months.
This is unbearable. It is not something that she can stand, and it is
not something that we should strap the American people with. But small
business after small business, State by State, is faced with the same
thing today: They can't buy with the effective tools that large
corporations can.
We have spent over 30 hours debating whether we would even proceed to
debate the bill. This is incredible. Now we are getting to a point
where we will debate the bill and we will consider amendments. We may
consider alternatives such as my colleague from Arkansas will discuss.
But make no mistake, this is a very needed debate. This is not a
needless debate about health policy. This is one that we have needed to
have. We have needed to have a policy in place for years now. It is
incredible to me that we could think that small business can continue
to hold on just like the fingertips on a windowsill.
Across the country, the No. 1 issue facing small business today is
the rising cost and the lack of access to quality health care. Earlier
this week, we debated liability reform, something that is driving
doctors out of the profession, that is affecting new medical students
as they choose a specialty, where they are shying away from specialties
like neurology, OB/GYN, things that to a population that is growing
older and a population that we want to repopulate, as families decide
to have children, are absolutely vital.
But we were denied the ability to proceed, denied the ability to go
to a debate because people said we don't have a liability problem in
America. Yet I gave a firsthand story about a friend of mine who is a
nephrologist. I don't even know what that is. But he told me this: We
are likely not to get sued. He told me that in the past 2 years his
premium has gone up 300 percent. Some come to this floor, and they say
this is not a crisis. We don't have a problem. Medical liability does
not contribute to the rising cost of health care.
Any place in health care that experiences a 300-percent increase in a
matter of years has an inflationary factor on everybody's health care.
That is one example of a profession that is not the most likely to be
sued, as are the OB/GYNs, the neurosurgeons. But we were denied the
ability to move forward. It took us 30 hours to be able to debate the
assets that we find in S. 1955. Is it perfect? No. Is it a carefully
crafted piece of legislation that incorporates the State insurance
commissioners who are in the business of regulating insurance products?
Absolutely. It incorporates everything that everybody who sat around
the table who had an interest in this said had to be there. Change one
little piece, and now you have affected all the moving parts that
exist.
What are we trying to do? We are trying to make sure that small
business has the opportunity, if they choose, to provide for their
employees' health care coverage. Anybody who would be against that, I
can only assume that the only way they want to provide health care
coverage is if the Government provides it.
I will tell everybody a story. I was elected to the House of
Representatives 12 years ago. I worked for a small business, less than
50 employees. When I came here, I had an option of all the choices I
could choose for insurance. I chose the company and the exact same plan
that I had before in a company of 50 employees. What was the only
difference in my health care coverage? It cost me $50 more a month to
be a Federal employee and to have that health insurance. But there are
some up here who suggest that the Federal Government should negotiate
everybody's health insurance. From firsthand experience, the Federal
Government is the last one I want negotiating anything for me. I would
be willing to bet that my constituents feel the same way.
Ask the business owners I referred to if they want the Federal
Government negotiating their health care policies. Absolutely not. They
want the option of being able to offer health insurance.

[[Page S4254]]

These employees today have two choices--nothing and nothing. This
debate is very simple. It is about whether we are going to offer them
something versus nothing. This is a debate that is well past due. It is
a debate that has to be completed. I am not convinced today that this
bill will find it to final passage. I think it will get blocked. I
think it will be filibustered.
I think Members of this body will, in fact, block the consideration.
In North Carolina, this will block 900,000 individuals who could have
health insurance who, because somebody here decides we are not going to
move forward, won't have that option. Their choices tomorrow will be
nothing and nothing.
Health insurance costs are on a track to becoming the largest portion
of an employer's total benefit package--more so than what employers are
putting into retirement plans or 401(k)s.
Madam President, I am going to continue to come to this floor, and I
am going to continue to talk about real people across this country, not
just in North Carolina--the ones who have the horrors of no choices and
cannot continue to afford the policies they have, the employers who
really do want to offer their employees a benefit because it enables
that employee to stay with them. I am going to continue to read these
stories in hopes that my colleagues on the other side will understand
that this is about real people, that for once maybe they will look at
the human face of this issue and understand that there are casualties
all across this country.
I yield the floor.
The PRESIDING OFFICER. The Senator from Arkansas is recognized.
Mrs. LINCOLN. Madam President, I, too, would like to echo the Senator
from North Carolina, that this is a debate which is extremely critical.
It is an issue which is--particularly from my standpoint--one that I
get most consistently when I return home to Arkansas. I don't think the
debate is whether it is a critical issue for us to discuss and come up
with a solution; the critical question here is, Are we really doing our
best? Are we really working hard to produce the best product we
possibly can for the constituency that really needs us the most?
Small businesses are our No. 1 employer in Arkansas. They are the
engine of our economy all across this great Nation. There is no doubt
that they deserve the same quality of health care we have here as
Members of Congress.
The Senator mentioned that, as he left small business and came to
Washington, his premiums went up. The statistics show us that the
premiums for Federal employees rise at a disproportionately lower
percentage rate than the premiums rise in the small business market. We
have seen drastic increases in the premiums in the small business
market over the last several years. However, while we also, as Federal
employees, have seen increases in our premiums, they have not been
anything compared to the increases that have been seen in the small
business marketplace. So there may have been some changes, but the
point is that we have a good product that we enjoy as Members of
Congress. The quality control on what we have is tremendous because we
adhere to the State mandates and what States have seen in their States
to be important to their constituency.
All States are different, but most of the States are consistent when
it comes to things such as diabetes, maternity care, well baby care,
immunization, cancer screening--things that have really made a
difference not only in people's quality of life but also in terms of
the cost of health care. States such as Connecticut actually cover
anything--or mandate the coverage of Lyme disease because in
Connecticut you actually see a prevalence of that. States have the
choice. It is the State's right to be able to make sure that what their
constituency wants in that product is going to be there. I believe that
has worked very well. It is something we want to maintain. It is a
quality control we enjoy, and there is no reason small businesses
should not, also.
Madam President, I wish to comment and lend my voice to the fact that
this is a critical debate, one about making sure we are providing for
every other American out there, particularly in small businesses, the
same opportunities and the quality of health care we enjoy.
I wish to address some of the issues that have been brought up in
this debate that I have heard about the bill that I have worked hard on
over the last 3 or 4 years--a bill Senator Durbin and I helped each
other put together after realizing what a great job the Federal
Government had done in bringing the best of what Government can do in
its oversight and the best of what private industry and competition in
the marketplace can bring. It brings it to us as Federal employees and
Members of Congress, and has for over 40 years, and it keeps down an
administrative cost that is drastically lower than private plans out in
the small business marketplace. At some point, it is somewhere around
25, or plus, percentage points lower in terms of administrative costs,
which is practical in this day and age and something that is essential.
I applaud Senator Enzi in his effort and hard work at bringing about
this issue and focusing on how important it is. I hope that the debate
and our willingness to work to produce a good product is genuine and
that we can actually do what is best for the American people and that
we don't get caught up in a lot of the details of procedure here so
that we miss the forest for the trees.
On the other side of the aisle, they have argued that our bill is
just another costly Government program, which will cost taxpayers a ton
of money. We are getting ready to spend a ton of money tomorrow in
extending tax cuts that haven't even expired and don't expire for
several years. We are going to spend a tremendous amount of money--$50
billion plus--on extending those tax cuts which don't even come up for
expiration for another couple of years.
Here we have an opportunity to provide a tax cut to small business
that could actually make an immediate impact on bringing down their
cost of health insurance for themselves and their employees. This is
kind of the first time I have ever noticed my colleagues on the other
side, who all of a sudden don't want to provide a tax cut to small
business because it costs. Yet we are going to have multiple tax cuts
brought before us that come at a tremendous cost to the Government and
to the deficit, and we don't even need them yet. Yet here is an
opportunity to provide a direct tax cut, a credit, to small businesses
to engage in the health care marketplace, encourage them to provide
much needed health insurance for their employees, for themselves, and
for the self-employed, and all of a sudden it is a cost that is just
out of control. But if you look at that cost, it is amazing. It is
maybe a third of the cost of the HSA that the President has been
proposing. Yet we have the possibility and capacity under this plan to
serve millions more Americans with health insurance--health insurance
that is backed by the State mandate and the Office of Personnel
Management, a proven negotiator, that negotiates for us, Members of
Congress. So I just have a real problem with that argument.

The fact is that SEHBP won't create any new bureaucracy. Our plan
will be run by the same agency that runs the health care program for
all Federal employees and Members of Congress. The administrative costs
are less than 1 percent. There is no new bureaucracy created. It
already exists in the Office of Personnel Management. We might have to
increase some of those people in that office, but we don't know what is
going to happen at the Department of Labor, which is charged with
implementing Senator Enzi's plan. There is no one in the Department of
Labor who has ever done that. There is no part of that agency designed
or created in order to do that. We would have to reinvent the wheel to
provide a section of the Department of Labor that would be able to
institute the Enzi bill.
In fact, most of the costs, as I have said, of our benefit plan for
small businesses come in the form of a tax cut. So our costs are not
administrative. We actually bring those down. Our costs are not an
implementation. Our costs are providing the assistance to small
business to actually get into the marketplace because we know that the
more small businesses that get into the marketplace, the greater the
pool.
I doubt there is anyone here who will argue with the fact that the
real key to

[[Page S4255]]

providing good, quality, low-cost, consistent health insurance is in
the volume of the pool because we all want to make sure that
competition in the marketplace is what is driving the issue here. When
you have a larger pool to negotiate with private industry, you are
going to be able to negotiate a better deal. It is a better deal for
everybody.
Forty-six million Americans are not getting health insurance now.
Disproportionately, the largest percentage of those 46 million are
working in small businesses. They are not getting health insurance.
Health insurance companies should love the idea of being able to
increase their market share with those numbers of people. In fact, we
have worked hard over the last 2 or 3 years with the insurance industry
to make sure that what we were creating was improvement on what was
already in existence other than the Federal plan.
The PRESIDING OFFICER. The Senator has used 10 minutes.
Mrs. LINCOLN. Madam President, I ask unanimous consent for an
additional 1 minute.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mrs. LINCOLN. Madam President, I believe it is so important that we
heed the words of most of our parents, I am sure, when we were growing
up, and those are: If it is worth doing, it is worth doing right.
We enjoy, as Federal employees, an incredible opportunity to provide
health insurance for ourselves and for our families which provides
real, substantial quality. It is not something we buy into with the
idea that we will never get sick; we buy into it knowing that maybe we
are just one automobile accident or one chronic illness away from
needing comprehensive health insurance.
The increases my colleague from North Carolina talked about in terms
of the number of people who would be added, those are immediate and
they are temporary. They are mostly young, healthy people. The fact is
that if we don't include everybody and we don't make sure all of the
different chronic illnesses that exist out there are going to be
offered, those who are less healthy are going to be shut out, they will
become more costly, and the first time one of those young individuals,
healthy individuals, has an accident or reaches a chronic condition,
they too are not going to be covered under this plan. So I hope we will
heed the idea that it is important to do what is right.
We have an opportunity here, at no additional cost. We could
eliminate it, if the other side doesn't want to provide a tax cut to
small business, that is OK. But we should maintain the quality, and I
hope my colleagues will join me in that.
The PRESIDING OFFICER. The Senator from Georgia is recognized.
Mr. ISAKSON. Madam President, I was here about 15 minutes ago, and I
learned one inevitable fact: this body is long on rhetoric and
oftentimes short on results. In the case of health insurance and health
coverage for the American people, we stand at a point in time when we
have a chance to produce real results.
I have listened to the arguments over the last couple of days. In
fact, I presided last night and got to listen to some of these negative
arguments about S. 1955. I wish to try, in a positive way, to talk
about the result that it affords and brings to the American people. I
want to do it by, first of all, trying to establish credibility.
The reason I say that is, most of us come to the Chamber and speak
oftentimes on subjects about which we have had few life experiences.
Most of the Members--certainly a majority--have never really been in
the private sector. Certainly, a lot have not been independent
contractors. None of us right now are in the marketplace for health
insurance in America.
For 33 years before coming to the Senate, I ran a small business. I
had 200 employees but 800 independent contractors. My employees had
medical benefits because we qualified under ERISA. My independent
contractors, who were my salespeople, the assets of the company,
because of Federal law and IRS treatment, were not allowed to be
offered a benefit. They were subject to the free market, to buy spot
insurance. They weren't the young and healthy. They were middle age,
second- and third-career people, mostly women, and some men. They were
very difficult people to cover in the spot market.
As a legislator during those 33 years, while I ran a small business,
I did a ton of work on health care. In fact, I was the author of one of
the State mandates in Georgia for direct access for dermatological
coverage. I did so for a passionate reason: I am the survivor of a
melanoma. My doctor caught it in time, and it was removed in time, and
I am here today. I have great respect for that mandate for direct
access.
As some of the people who have spoken--in fact, many on the other
side have talked about the horrible thing this bill does by not
including all of the mandates required of all of the States in this
country. And the ads we see in some of the periodicals we read portend
we are removing the possibility of people to have coverages that are
mandated in their States. Let me address that and make the record
straight.

Currently, in the United States, there are 109 mandated medical
coverages in the 50 States and the District of Columbia. My State of
Georgia has 39. This bill doesn't preclude any of those from being
offered, but it doesn't mandate that they be offered, and it doesn't
allow small businesses to associate across the Nation, form a large
enough risk pool to be competitive in the marketplace and be able to
compete and provide insurance to the American people who do not have
insurance.
The first fantasy that has been purported as fact is that this bill
takes away mandates. It doesn't take a mandate away from a single
person who has it. What it does is give people who don't have any
insurance at all the chance to get good, solid, basic health care, and
when they get it, when they make their purchase decision, this requires
they make that decision by being shown, at the same time they are
presented with a basic policy, a policy that contains all the mandates
contained in the five most populous States in the country. The consumer
gets the choice that right now they do not have.
For the other side to allege we are taking away benefits, what we are
doing is providing opportunity to folks who have no opportunity. I defy
you to be 45 years old, a working carpenter with a wife and two kids,
out in the marketplace trying to buy spot insurance. Can you buy it?
Sure, if you want to pay $2,000, $2,500 a month, a price you can't
afford to pay and put food on the table and shelter as well. So what do
they do? They fly without coverage. When they get sick and they are
really sick, they go to emergency rooms, and they end up raising the
cost of health care to everybody, which raises the cost of health
insurance to everybody.
What this bill does and what Chairman Enzi has done, which is the
genius of it, it brings forth the ability of small businesses and
people who cannot afford the coverage to go into the marketplace and
buy health insurance.
On the mandate issue, there is no question that some of the insurance
that will come out of this process will not include every mandate,
maybe not all of the mandates, maybe not half the mandates. But what it
will include is good, basic health care, and if a family that doesn't
have good, basic health care coverage now all of a sudden has it, what
happens? They start practicing better health. They start having more
wellness. They start seeing physicians before they are sick rather than
after they are sick and in pain. What happens is, we have more
wellness, more preventive health care, and we have a lower cost of
health care in this country to all the Americans who have coverage.
For the other side to say that what we are trying to do is take
benefits away from people is disingenuous and wrong. We are trying to
preserve the benefits of people in America, and to the 45 million who
don't have any, we are trying to give them the opportunity.
For those who think the State knows best and therefore we ought to
mandate they can't do this, they are denying choice of the most basic
need in the United States of America, and that is the choice for a man
and a woman and their children to be covered in the medical needs they
have.
I can tell you that I spent most of my time running my business
trying to make sure there was some access to affordable health care for
those independent contractors to whom I could

[[Page S4256]]

not legally provide it. Over the 20 years I ran the company, it became
more and more difficult. And over those same 20 years, the cost of
health insurance went higher, higher, and higher. It went higher
because the mandates became more and more difficult to provide to those
individuals, in part because of the State mandates as well.
This opens a new door. It opens hope and opportunity for 45 million
Americans. It gives us the chance to cover maybe 11 million, maybe 12,
maybe 13. Senator Burr thinks 900,000 in North Carolina. The number I
have heard for Georgia is the same. But whatever the number, S. 1955
offers hope and opportunity for affordable health insurance and better
health care to millions of Americans. It takes away mandates from no
one and ensures that the customer always has the choice of buying the
product and the coverage they want and they can afford.
Chairman Enzi and the committee have done a great service to the
American people. It is time for this Senate to do great service to
their constituents. Give them a chance to have access to affordable,
accessible health insurance for the 45 million Americans who do not
have it.
I yield the floor.
The PRESIDING OFFICER (Mr. Thune). Who yields time? The Senator from
New Jersey.
Mr. LAUTENBERG. Mr. President, how much time do we have remaining on
our side?
The PRESIDING OFFICER. There is 14 minutes, but each Senator has been
allotted no more than 10 minutes.
Mr. LAUTENBERG. It is my understanding that there is no request for
use of time on our side, so I ask unanimous consent that I be able to
use all of the remaining time.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. LAUTENBERG. Mr. President, we are in the midst of Health Week.
Apparently, during Health Week, we don't pass any of the bills the
American people want but, rather, we schedule procedural votes.
Why aren't we taking up something such as stem cell research? That is
what the American people want to see us do. There is such value in the
use of stem cells for research and potential treatment of all types of
diseases. Despite all the promises of stem cell research, we are not
working on it this week. This week we are simply doing our political
stuff: posturing for the next election.
There are other important health care issues besides stem cell
research that we could be taking up; namely, Medicare. We should be
discussing that on the floor of the Senate. We should be passing
legislation to extend the Medicare enrollment date past May 15.
Right now, under the present Medicare drug plan, if you don't sign up
by this coming Monday, you will be penalized permanently for signing up
late.
Millions of Americans are having serious problems understanding this
outrageously complex Medicare plan, but the administration, the
President of the United States is saying: Hurry up and make the choice,
we are not going to extend the enrollment date. It is insulated from
what reality is. It is too bad.
In New Jersey, seniors have to choose among 45 plans offered by 19
providers, and we are saying rush, rush, rush. Most people can't get
through the language, no less the dates and those requirements. But the
administration is saying to my constituents that even though their
health is at issue, they have to rush to a decision. It sounds like
this is a deadline that nothing can move and, unfortunately, that is
the truth coming from this administration.
If we want to talk about health initiatives, Republican health
initiatives, let's talk about the one that is in place, this horrible
new Medicare plan.
We have seen the Republican model of health care, and it is not
pretty. In fact, many have called it a disaster. One need only pick up
the local newspapers to see this disaster play out from Maui to Miami,
from Portland, OR, to Portland, ME. The new Medicare drug plan is
failing our seniors.
We see it demonstrated in this placard in the headlines: The Boston
Globe:

Many seniors say Medicare drug plan will not help them.

Newsday:

Medicare guide is in need of Rx.

The New York Times:

Drug plan enrollment opens amid confusion.

It goes through all of these well-known newspapers, showing the
opinions they are hearing from their constituents.
How did we get there? This Medicare Part D Program is an example of
the majority vision for the future of health care in our Nation. One
thing that is pretty clear about Medicare Part D is that whoever wrote
it was clearly not focusing on the health of our seniors, and if the
goal were to help our seniors, there would not be this thing called the
donut hole, a gap in coverage.
Many Americans have not heard about it or don't know what this
coverage gap is. When I explain it to people listening at home, they
are not even going to believe it. But it is true because I have heard
about it when I address people all across our State.
The way the program works is that for many people, in the middle of
the year when you have spent $2,250 on drugs, which is not a lot of
money considering the drug use for preserving health and for prolonging
life, their prescription drug coverage will stop at $2,250. They will
not have any coverage, but they will still have to pay the premium.
What does that mean? It means that sometime in the summer or fall of
this year, millions of Americans will walk into a pharmacy for their
medication and the pharmacist is going to ask them for hundreds of
dollars in payment. When the person says, Wait a minute, I have
Medicare, the pharmacist will say: Yes, but you are in the donut hole,
when you don't get any benefit until you reach spending over $5,100; so
you will have to pay the full price now.
It makes no sense. It is hard to understand, but unfortunately it is
true and it is happening. My office has been contacted by constituents
who experience this problem, and we are trying to help them, but this
is only the beginning.
Another senseless component of the Republican Medicare law is the
prohibition that prevents Medicare--can you believe this--prevents
Medicare from negotiating prices directly with the pharmaceutical
companies. The VA permits that and the discounts are significant. But
you can't do that in Medicare because the focus is to protect the
companies rather than it is to protect the citizens.
I come from New Jersey, home of the world's leading drug companies.
And I admire these companies. Their discoveries have saved the lives of
untold millions of people. To be quite honest, they are often targets
of unfair criticism. But I don't see any reason to prohibit Medicare
from negotiating prices with these companies. Medicare, the largest
health care system in the entire world, is prevented from negotiating
with these companies. The Republican Medicare law prohibits Medicare
from negotiating for a good price, and there is no valid reason for it.
When I talk with my constituents about this new Medicare law, all of
them ask the same question: Why is this program so complicated? That is
a good question. The program is complicated because the people who
wrote it were not focused on helping seniors. Rather, they were focused
on promoting ideology. The Republican ideology is now destroying
Medicare because it is based on the need to privatize everything,
outsource Medicare.
If the goal were to help seniors get their prescription drugs, the
result would not be so complicated. We can't blame seniors and their
families for being confused when we present them with the kind of
complex picture they see.
The Democrats invented Medicare, and when it comes to serving the
American people, running an effective Government, we do know how to do
it. I think it is pretty obvious now in the wake of this Medicare mess
and the bungled response to Hurricane Katrina that there is little
ability to run our Government. It doesn't seem to work. Incompetence
runs rampant.
Why can't they run a Government? Because they always want to farm out
the hard work to the companies--Halliburton, the HMOs, and the list
goes on and on. They even want to outsource our air traffic control
system. Remember that fight? And that still looms in front of us. I
will give you a real-world

[[Page S4257]]

example of why the Republican insistence on privatizing Medicare is
hurting America's seniors. In one of my local papers back in New
Jersey, the Bergen Record, there was an article about a pharmacist who
has been trying very hard under tough circumstances to help his
customers with this new Medicare program. One of the customers needed a
25-milligram version of a drug because her doctor found that the 50-
milligram pill was causing too many side effects. When the pharmacist
filled the 25-milligram prescription, the Medicare drug plan, run by
United Healthcare, said they will not cover the 25-milligram, the
smaller milligram, version. It is hard to understand.

United Healthcare told the pharmacist to cut the 50-milligram pills
in half. The pharmacist correctly told the insurance company that it
was a sustained-release drug and cutting it in half would make the pill
ineffective. After waiting for some time on hold with United
Healthcare, the pharmacist was told the customer would have to go back
to her doctor and ask the doctor to file an appeal with United
Healthcare, looking for special permission to get the smaller dose of
the pill.
That is what real seniors are going through every hour, every day
under this drug program.
I want to talk about United Healthcare in particular. United
Healthcare paid its CEO, William McGuire, $124 million last year. That
is right. The CEO of United Healthcare made almost $124 million in
2005. Now, if they were making widgets, that would be all right. But
they are supplying health care to seniors and having this man walk away
with millions of dollars--when the people who need health care are
paying for it--it is not right. Those people are paying for that kind
of a salary, that kind of an asset base.
The seniors in my State are upset, while the real beneficiaries of
the Republican Medicare bill are still paid these outrageous salaries.
It doesn't make sense. It is a disgrace.
The question has been asked: Should we scrap this program and do a
real Medicare drug benefit? Maybe. But I would say this to the American
people: As long as the same group is running this Congress, you are
going to see more of the same happening. All we have to do is look at
the condition that we find ourselves in over in Iraq, not knowing
whether we are going or whether we are staying, and lives are still
being lost. The cost for that war is going to be somewhere around half
a trillion dollars before this year is over, and we are funding it with
supplementals that carry all kinds of pork-laden projects. The
management is terrible.
Management of the environment is terrible, when we look at what is
happening and we see that snowfields in Mount Kilimanjaro in Africa
that were there since the beginning of time will no longer be there in
a few years, when we see that Glacier National Park will soon not have
a glacier there, having had glaciers there since the beginning of time.
The glaciers are melting in front of our eyes. If you look at pictures
of animals up in Alaska, such as the polar bear, they are scrawny. They
don't have the body size they should have when they are not getting
sufficient nourishment. There is nothing being done about that. There
is nothing being done about global warming as the Earth that we live on
gets warmer and as the threats of flooding all over the seacoast States
and communities becomes more and more apparent. So there is a question
of competency that we have to look at. It is certainly not reflected in
this Medicare plan.
Although it is late, I wish the President would show some good
heartedness and say: You know what, seniors of America, we are going to
help you. We know you can't get through this Medicare drug plan in
time, so what we are going to do is delay it a few months. What is the
big deal? I don't get it. Instead of permitting people to adequately
review these plans so they can understand what they are getting into,
there is a push to sign up. It is one that I don't understand.
Mr. President, I yield back the remainder of my time.
The PRESIDING OFFICER. The Senator from Colorado is recognized.
Mr. ALLARD. Mr. President, I understand we are in morning business?
The PRESIDING OFFICER. We are. That is correct.

____________________